Provider Demographics
NPI:1881747640
Name:KLOBOVES, RYAN E
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:E
Last Name:KLOBOVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12073 FLAGSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037
Mailing Address - Country:US
Mailing Address - Phone:317-578-0085
Mailing Address - Fax:
Practice Address - Street 1:5457 WEST 38TH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-291-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010746B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200522010Medicaid